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NPI Code Detail

MEDICARE: DEREK CHRISTOPHER BONTRAGER CRCST,CFA

MEDICARE: DEREK CHRISTOPHER BONTRAGER CRCST,CFA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZC0007XSurgical Assistant114919AZ

General Provider Information

NPI Number : 1518193382
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK CHRISTOPHER BONTRAGER CRCST,CFA
Provider Business Mailing Address
First Line : 18444 N 25TH AVE STE 310
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-1266
Country : US
Telephone Number : 623-241-8741
Fax Number : 623-544-5531
Provider Business Practice Location Address
First Line : 1840 N JASPER DR STE 2
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-1634
Country : US
Telephone Number : 866-974-2673
Fax Number : 866-939-2673
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2009
Last Update Date : 01/14/2026

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